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On Saturday evening an old adage proved not to be true. History did not repeat itself. Fifteen years earlier, a Democratic-led House of Representatives failed to enact major health reform legislation put forth by a Democratic president. This time, the same political constellation led to a different result. A major health reform bill was passed, albeit by a close margin. This legislation is as sweeping as any healthcare bill enacted since Medicare.
But a note of caution is needed as we move into the final phases of the congressional debate. It relates to the state of public opinion. When Medicare was enacted in 1965, 62 percent of the public supported its passage. When the ill-fated Clinton health plan did not pass the House in 1994, support was between 39 percent and 43 percent. In recent polls, public ratings of the congressional and Obama health reform proposals are much closer to those for the Clinton plan than for Medicare. Support for enactment in recent polls ranges from 34 percent to 49 percent with the most recent suggesting growing public opposition since the summer. This is the case even though many of the policy elements of the current House legislation are popular with the public, such as requiring insurers to cover people with pre-existing conditions, and the presence of a public option offered as a competitor to private health plans.
But polls show countervailing concerns about the congressional plans. These involve the potential impact of the bills on Americans’ health costs and affordability, their taxes, the extent of government interference in their health care decisions, and worries that health care for those receiving Medicare will deteriorate. Regardless of public enthusiasm for health reform as a principle, and support for many policy elements in the House bill itself, most Americans do not see their healthcare situation as getting better if this legislation is signed into law, and some see their situation as getting worse.
In the weeks ahead, Americans are unlikely to read the 2000-page House bill. Rather, they will form their judgment about the final legislation based on others’ assessments. They will rely on those whom they trust as intermediaries to clarify its impact on them. Many of those who will be most influential will not be political figures working in Washington. Polls suggest they may be leaders of physicians’ and nurses’ groups, seniors' groups, and organizations advocating for patients with serious illnesses. Also they may rely on the views of major media figures and experts interviewed frequently.
The American public was promised throughout the presidential campaign that major reform if enacted would improve their current health care situation. At the moment they are not convinced that this will be the case. Changing their perceptions may be critical if a bill as extensive as the one enacted by the House is to be passed by both houses of Congress in the next few months.